An Uncommon Cause of Weight Loss

Aims Case report

Methods Case report

Results 59-year-old gentleman was referred to clinic for weight loss of 10kg over 3months. He had appendicectomy and partial colectomy in mainland China 20years ago for intestinal obstruction, partial gastrectomy for perforated peptic ulcer 10years ago. Detailed operative record was not traceable.For years he has had on and off diarrhea, significant weight loss over the recent 3months. Blood tests showed hypokalemia, low B12, macrocytic anemia, hypoalbuminemia. Upper endoscopy showed Billroth II gastrectomy otherwise unremarkable. Barium meal and follow-through showed partial gastrectomy with normal transit time from stomach to colon. Colonoscopy showed poor bowel preparation with sticky stool obscuring mucosal surface; two small bowel-colon anastomoses at 50cm from anal verge. Unremarkable PET-CT and albumin scintiscan. He suffered an episode of severe hypoalbuminemia, hypokalemia, pulmonary edema complicated by septicemia, DIC necessitating intensive care.

A second colonoscopy showed very poor bowel preparation again. Gastric remnant was reached at 45cm, which was connected to a small bowel limb. Contrast meal and follow-through repeated; contrast first seen flowing down to gastric remnant then distal transverse and descending colon. On further infusion, contrast went down efferent limb of gastrojejunostomy into proximal small bowel, confirming the suspicion of entero-colonic fistula. Repeated upper endoscopy revealed a fistulation from gastric remnant at the posterior wall of anastomosis to the colon.

After improvement of patient’s nutritional status, surgical repair was undertaken. Intra-operative found distal gastrectomy with antecolic gastrojejunostomy with part of the transverse colon included at the posterior wall of the gastrojejunostomy. The anastomosis was disassembled, gastrojejunostomy revised as roux-en-Y reconstruction.

Conclusions Gastrojejunocolic fistula is a rare finding in current practice, but a high index of suspicion should be maintained in patients with a history of gastric surgery presenting with any of the symptoms of chronic diarrhea, weight loss and classically but not necessarily fecal vomiting.

Citation: Chu P ¹ eP195 AN UNCOMMON CAUSE OF WEIGHT LOSS. Endoscopy 2021; 53: S160.

Publication History

Article published online:
19 March 2021